DESCRIPTION: A cohort of 403 VLBW (<1500 g) neonatal care survivors, born during August 1988-June 1991, have been followed to ages 5-8. The time period of birth includes the approval dates for surfactant therapy. Hence, the first children to be treated with surfactant in general neonatal ICU (NICU) practice are now entering school age, providing a first opportunity to evaluate school performance, and to assess true chronicity of respiratory limitations. The existing cohort provides a unique opportunity for such evaluation, as it spans the surfactant approval period, is larger than other U.S. follow-up cohorts, and is representative of NICU survivors in a geographic area. The proposed research will take advantage of the opportunity to tap into standardized school achievement testing in the third and fourth grades and a wealth of other school record information. Recently validated and standardized portable peak flow measurement devices will be utilized for pulmonary assessment as the cohort is geographically dispersed. A large NICU and follow-up data base on the cohort contains extensive baseline assessment of respiratory disease, neonatal treatments and diagnoses, as well as functional assessment, health status and health care utilization at ages 4-6. The addition of data up to age 10 will confirm or dispute findings from ages 4-6 that functional outcome may be lower among children born after surfactant was released for marketing, and that the prevalence of long-term respiratory problems has remained the same. The new outcome data to be collected include school performance, from school records, parent and teacher questionnaires, respiratory function by peak flow meters and respiratory symptoms and respiratory medications by parent interview and questionnaires. These data will be addressed by: 1) how VLBW children compare to norms and to comparison groups from the same schools and districts; 2) whether there has been a time trend across birth years; and 3) what factors are predictive, utilizing baseline, early childhood and concurrent data.